256層螺旋CT灌注成像高壓電損傷對肢體保存的應(yīng)用研究
發(fā)布時(shí)間：2019-05-31 17:12
【摘要】：目的探索256層螺旋CT灌注成像技術(shù)對于高壓電后對四肢損傷保存肢體的應(yīng)用價(jià)值 材料與方法選擇高壓電損傷患者72例,其中接受四肢灌注檢查者67例,常規(guī)四肢CTA檢查者5例。按照手術(shù)后截肢與否,將67例接受四肢灌注檢查者分為截肢組22例及未截肢組45例。將MSCTP檢查結(jié)果(肌肉微循環(huán)灌注信息及相應(yīng)部位血管CTA圖像)與手術(shù)、病理對照,以及進(jìn)行自身、雙側(cè)對照。將灌注所得圖像傳入Phillips公司專屬EBW工作站,用Functional CT-general模式行灌注圖像處理。(1)從灌注掃描結(jié)果中,選擇最佳時(shí)相提取CTA圖像,采用MPR、CPR、VR、MIP及高級血管分析(advantage vessel analysis, AVA)軟件進(jìn)行分析,獲得相應(yīng)部位的血管圖像；(2)截肢組及未截肢組中選定興趣區(qū)即得到包含血流灌注(BF),峰值增強(qiáng)(PEI),達(dá)峰時(shí)間(TTP),血容量(BV)的偽彩圖、具體量化數(shù)值及時(shí)間密度曲線(TDC)。72例均進(jìn)行血管等形態(tài)學(xué)分析,截肢組、未截肢組67例進(jìn)行t檢驗(yàn),其中對截肢組另外進(jìn)行判別分析,以比較各組肢體各部位灌注參數(shù)的差異。 結(jié)果1、高壓電損傷后肌肉、皮膚、骨骼CT影像表現(xiàn)：患者肌肉損傷在CT平掃、增強(qiáng)圖像上一般表現(xiàn)為低密度影；皮膚損傷表現(xiàn)為皮膚局部缺損、皺褶；骨骼破壞后表現(xiàn)為骨皮質(zhì)不連續(xù)、錯(cuò)位。2、高壓電損傷后CTA表現(xiàn)：CTA對血管顯示較為清晰,損傷血管表現(xiàn)為節(jié)段性狹窄、跳躍顯影或血管遠(yuǎn)端呈鼠尾狀閉塞、中斷。3、高壓電損傷后CT灌注表現(xiàn)：高灌注、低灌注及無血流灌注表現(xiàn)。各組參數(shù)分析如下：1)截肢組：a、患側(cè)截肢平面下份與健側(cè)相對應(yīng)下份層面比較,BF值：前者后者,差異有統(tǒng)計(jì)學(xué)意義；PEI值：前者后者,差異有統(tǒng)計(jì)學(xué)意義;BV值：前者后者,差異無統(tǒng)計(jì)學(xué)意義；TTP：前者后者,差異無統(tǒng)計(jì)學(xué)意義�；紓�(cè)截肢平面上份與健側(cè)相對應(yīng)上份層面比較,BF、PEI、BV、TTP值：前者均后者,差異均無統(tǒng)計(jì)學(xué)意義。患側(cè)截肢平面與健側(cè)相對應(yīng)平面比較,TTP值：前者后者,差異有統(tǒng)計(jì)學(xué)意義；BF、PEI、BV值：前者均后者,差異均無統(tǒng)計(jì)學(xué)意義。b、患側(cè)截肢平面上份與患側(cè)截肢平面比較,BF、PEI、TTP值：前者均后者,差異無統(tǒng)計(jì)學(xué)意義,BV值：前者后者,異無統(tǒng)計(jì)學(xué)意義。c、患側(cè)截肢平面下份與患側(cè)截肢平面參數(shù)比較,BF、PEI值前者后者,差異無統(tǒng)計(jì)學(xué)意義；BV值：前者后者,差異有統(tǒng)計(jì)學(xué)意義。a組數(shù)據(jù)kappa值均0.4,一致性較差。所以，，采用BF、PEI、TTP、BV值對于是否為患側(cè)截肢各平面與健側(cè)相對應(yīng)各層面的預(yù)測的實(shí)際意義不大。b組kappa值為0.390.4,一致性較差。所以,采用BF、PEI、TTP、BV值對于是否為患側(cè)截肢平面上份與患側(cè)截肢層面的預(yù)測的實(shí)際意義不大。c組kappa值為0.420.4,一致性尚可。所以BF、PEI、TTP、BV值對于患側(cè)平面下份與患側(cè)平面的預(yù)測有一定的實(shí)際意義。2)未截肢組：未截肢患者BF、PEI、BV值：患側(cè)健側(cè),差異均無統(tǒng)計(jì)學(xué)意義。TTP患側(cè)健側(cè),差異無統(tǒng)計(jì)學(xué)意義。 結(jié)論應(yīng)用256層螺旋CT灌注診斷四肢高電壓損傷,能夠獲得清晰的血管CTA圖像及不同損傷部位灌注參數(shù)值,并且這些灌注參數(shù)對皮瓣修復(fù)的預(yù)后具有評判價(jià)值;MSCTP對區(qū)別高壓電損傷截肢與否一定的幫助作用。MSCTP能夠?yàn)榕R床提供診斷、治療高壓電損傷的方便和安全、定性、定量的檢查方法。
[Abstract]:Objective To explore the application value of 256-slice spiral CT perfusion imaging in the preservation of limbs after high voltage Methods:72 patients with high-voltage injury were selected from the materials and methods, of which 67 subjects were treated with 4-limb perfusion and 5 cases of conventional four-limb CTA. Example.67 patients with four-limb perfusion were divided into the amputation group (22 cases) and the non-amputation group (45) according to the post-operation amputation. Example: MSCTP examination results (muscle microcirculation perfusion information and corresponding site vessel CTA images) were compared with the procedure, the pathology control, and the self, bilateral pair In accordance with. Transfer the resulting image to the dedicated EBW workstation of the Phillips company and fill the image with the Functional CT-general mode. (1) From the results of perfusion scanning, the best time phase was selected to extract the CTA image, and the software of MPR, CPR, VR, MIP and advanced blood vessel analysis (AVA) was used for analysis to obtain the blood vessel map of the corresponding site. (2) The selected areas of interest in the amputation group and the non-amputee group were pseudo-color images including blood flow perfusion (BF), peak enhancement (PEI), peak time (TTP), blood volume (BV), specific quantification values and time density curves (TDC). The t-test was performed in 67 cases of the non-amputated group, in which the amputation group was further analyzed to compare the difference of the perfusion parameters of each part of the limb. Results 1. The image of the muscle, skin and bone after high-voltage injury showed that the muscle injury of the patient was on the CT level, and the enhancement of the image was generally low-density shadow; the skin injury was manifested as the local defect of the skin, the fold, and the bone cortex was not continuous and wrong after the bone destruction. 2. CTA in high-voltage injury: CTA is clear in the display of blood vessel, and the damage to the blood vessel is a section of the section of the section, the jumping development or the distal end of the vessel is in the shape of a tail-like occlusion, and the interruption.3. CT perfusion after high-voltage injury: high perfusion, low perfusion and no blood flow irrigation. Note: The parameters of each group are as follows:1) amputation group: a. The lower part of the amputation plane of the affected side is compared with the healthy side at the lower part level, and the BF value: the former is the latter and the difference is of statistical significance; the value of the PEI: the former is the latter, the difference is of statistical significance; the value of BV: the former is the latter, and the difference is not statistical Significance of learning; TTP: The former is the latter and there is no statistical difference between the latter and the latter. The value of BF, PEI, BV, and TTP: The former was the latter and the difference was not statistically significant. The value of TTP: The former is the latter, the difference is of statistical significance, and the value of BF, PEI, and BV: The former is the latter, and the difference is no statistics. The value of BF, PEI and TTP: The former is the latter, the difference is no statistical significance, the value of BV: The former is the latter, and the difference is non-statistical. Study significance. c. The lower part of the amputation plane of the affected side is compared with the plane parameter of the amputation plane at the affected side, the value of BF and PEI is the latter, and the difference is not significant; the value of BV: the former is the latter, and the difference is statistics study significance. A group data kappa value of 0.4, consistent Poor sex. Therefore, the value of BF, PEI, TTP, and BV is used to determine the actual meaning of the prediction of each plane and the healthy side of the amputee for the affected side. The value of kappa number in group b was 0.390.4, and the value of kappa value was 0.390.4. Poor sex. Therefore, the value of BF, PEI, TTP, and BV is used to determine the actual meaning of the prediction of the amputated plane on the affected side and the amputation level on the affected side. The value of kappa value in group c was 0.420.4, and the value of kappa value was 0.420.4. The values of BF, PEI, TTP and BV have a certain practical significance for the prediction of the plane of the affected side and the plane of the affected side.2) No amputee: BF, PEI and BV in the non-amputated patient: no statistics on the side-to-side and the difference of the affected side. Significance of learning. There was no statistical difference between the side and the side of the affected side of the TTP. Conclusion Using 256-slice spiral CT perfusion in the diagnosis of high voltage injury of four limbs, it is possible to obtain clear blood vessel CTA images and different lesion site perfusion parameter values, and these perfusion parameters can be used for the prognosis of skin flap repair. Evaluated value; MSCTP is certain to distinguish the amputation of high-voltage electric injury. The MSCTP can be used for clinical diagnosis, convenience and safety for treating high-voltage damage, and qualitative and quantitative analysis.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R816.8;R647
本文編號：2489874
[Abstract]:Objective To explore the application value of 256-slice spiral CT perfusion imaging in the preservation of limbs after high voltage Methods:72 patients with high-voltage injury were selected from the materials and methods, of which 67 subjects were treated with 4-limb perfusion and 5 cases of conventional four-limb CTA. Example.67 patients with four-limb perfusion were divided into the amputation group (22 cases) and the non-amputation group (45) according to the post-operation amputation. Example: MSCTP examination results (muscle microcirculation perfusion information and corresponding site vessel CTA images) were compared with the procedure, the pathology control, and the self, bilateral pair In accordance with. Transfer the resulting image to the dedicated EBW workstation of the Phillips company and fill the image with the Functional CT-general mode. (1) From the results of perfusion scanning, the best time phase was selected to extract the CTA image, and the software of MPR, CPR, VR, MIP and advanced blood vessel analysis (AVA) was used for analysis to obtain the blood vessel map of the corresponding site. (2) The selected areas of interest in the amputation group and the non-amputee group were pseudo-color images including blood flow perfusion (BF), peak enhancement (PEI), peak time (TTP), blood volume (BV), specific quantification values and time density curves (TDC). The t-test was performed in 67 cases of the non-amputated group, in which the amputation group was further analyzed to compare the difference of the perfusion parameters of each part of the limb. Results 1. The image of the muscle, skin and bone after high-voltage injury showed that the muscle injury of the patient was on the CT level, and the enhancement of the image was generally low-density shadow; the skin injury was manifested as the local defect of the skin, the fold, and the bone cortex was not continuous and wrong after the bone destruction. 2. CTA in high-voltage injury: CTA is clear in the display of blood vessel, and the damage to the blood vessel is a section of the section of the section, the jumping development or the distal end of the vessel is in the shape of a tail-like occlusion, and the interruption.3. CT perfusion after high-voltage injury: high perfusion, low perfusion and no blood flow irrigation. Note: The parameters of each group are as follows:1) amputation group: a. The lower part of the amputation plane of the affected side is compared with the healthy side at the lower part level, and the BF value: the former is the latter and the difference is of statistical significance; the value of the PEI: the former is the latter, the difference is of statistical significance; the value of BV: the former is the latter, and the difference is not statistical Significance of learning; TTP: The former is the latter and there is no statistical difference between the latter and the latter. The value of BF, PEI, BV, and TTP: The former was the latter and the difference was not statistically significant. The value of TTP: The former is the latter, the difference is of statistical significance, and the value of BF, PEI, and BV: The former is the latter, and the difference is no statistics. The value of BF, PEI and TTP: The former is the latter, the difference is no statistical significance, the value of BV: The former is the latter, and the difference is non-statistical. Study significance. c. The lower part of the amputation plane of the affected side is compared with the plane parameter of the amputation plane at the affected side, the value of BF and PEI is the latter, and the difference is not significant; the value of BV: the former is the latter, and the difference is statistics study significance. A group data kappa value of 0.4, consistent Poor sex. Therefore, the value of BF, PEI, TTP, and BV is used to determine the actual meaning of the prediction of each plane and the healthy side of the amputee for the affected side. The value of kappa number in group b was 0.390.4, and the value of kappa value was 0.390.4. Poor sex. Therefore, the value of BF, PEI, TTP, and BV is used to determine the actual meaning of the prediction of the amputated plane on the affected side and the amputation level on the affected side. The value of kappa value in group c was 0.420.4, and the value of kappa value was 0.420.4. The values of BF, PEI, TTP and BV have a certain practical significance for the prediction of the plane of the affected side and the plane of the affected side.2) No amputee: BF, PEI and BV in the non-amputated patient: no statistics on the side-to-side and the difference of the affected side. Significance of learning. There was no statistical difference between the side and the side of the affected side of the TTP. Conclusion Using 256-slice spiral CT perfusion in the diagnosis of high voltage injury of four limbs, it is possible to obtain clear blood vessel CTA images and different lesion site perfusion parameter values, and these perfusion parameters can be used for the prognosis of skin flap repair. Evaluated value; MSCTP is certain to distinguish the amputation of high-voltage electric injury. The MSCTP can be used for clinical diagnosis, convenience and safety for treating high-voltage damage, and qualitative and quantitative analysis.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R816.8;R647
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